Usually intermittent, can be prolonged. [8] Most of the patients present with fever. [7] Fever in acute Chagas disease is often self-limiting. [8] Myalgia [1,6] This is a non-specific complain, but many patients present with this symptom. [7] Headache [explainmedicine.com]

The most important systemic manifestions of chronic Chagas disease are cardiac (cardiomyopathy presenting with a history of heart failure or arrhythmias) and GI (presenting with difficulty swallowing, abdominal pain, or history of constipation due to [dermatologyadvisor.com]

Diastolic filling pressures are often elevated and a small pericardial effusion may be present. [clinicaladvisor.com]

Critical Essential Core Tested Community Questions (2) (M2.ID.4691) A 45-year-old woman presents to clinic for an employment physical. She has no current complaints. [medbullets.com]

Chagas disease is both vector-borne and zoonotic, and T. cruzi is very genetically diverse, presenting unique challenges to understand its epidemiology and pathogenesis and to develop effective control programs. [med.unc.edu]

• Swelling

  Swelling is due to Trypanosoma cruzi infecting the eyelid when bug feces are accidentally rubbed into the eye, or because the bite wound was on the same side of the child’s face as the swelling. [cdc.gov]

  The swelling is due to bug feces being accidentally rubbed into the eye, or because the bite wound was on the same side of the child's face as the swelling. Photo courtesy of WHO/TDR. [slideplayer.com]

  Chagomas are boil-like, indurated (hardened), violet lesions with central oedema (swelling) that may persist for several weeks. Chagomas may be accompanied by swollen lymph nodes. [dermnetnz.org]

  […] at the site of the bite wound ( Chagoma ) typically occur in the face or extremities Romaña sign inoculation at the conjunctiva leads to swelling of the upper and lower eyelid nonspecific symptoms malaise fever anorexia can even be asymptomatic chronic [medbullets.com]

  […] blood-sucking insects (genus Triatoma, Rhodnius, and Panstrongylus ) and that occurs in both an acute and chronic form Note: The acute form of Chagas disease lasts for several weeks to months and is marked by mild symptoms (such as fever, fatigue, or swelling [merriam-webster.com]

• Congestive Heart Failure

  Antiarrhythmic drugs may be required, as well as therapy to combat congestive heart failure. If the heart involvement becomes chronic, treatment then must be aimed at management of the chronic heart failure. [medical-dictionary.thefreedictionary.com]

  Acute decompensated congestive heart failure with dilated cardiomyopathy : See symptoms of left heart failure and symptoms of right heart failure. [amboss.com]

  See sections for congestive heart failure, atrial fibrillation, ventricular tachycardia. IV. Management with Co-Morbidities. A. Renal Insufficiency. [clinicaladvisor.com]

  heart failure Immunocompromised patient with reactivation – most common presentations are meningoencephalitis, brain abscess, and acute myocarditis ARUP Lab Tests Tests generally appear in the order most useful for common clinical situations. [arupconsult.com]

  Cellular infiltration and cardiac necrosis Histopathological image of myocarditis at autopsy in a patient with acute onset of congestive heart failure due to viral infection. 7 Myocarditis is associated with an autoimmune reaction Streptococcal M protein [slideplayer.com]

• Surgical Procedure

  Symptom -specific supportive measures are used to treat chronic disease, such as: Pacemakers or antiarrhythmic drugs for patients with heart rhythm abnormalities Special diets, laxatives, and surgical procedures for patients with gastrointestinal complications [dermnetnz.org]

• Collapse

  […] diastole, and has a broad neck, yet a growing number of authors favor defining it more loosely, as any large area of left ventricular dyskinesia that lowers the ejection fraction. 2-6 Intraoperatively, a LV aneurysm may also be defined as an area that collapses [tmj.ro]

• Dyspnea

  Snapshot A 58-year-old man presents to the clinic with a 2 month history of cough, dyspnea on exertion, palpitations, and orthopnea. He immigrated from rural Bolivia when he was 25 years of age and visits Bolivia regularly. [medbullets.com]

  –2 weeks ) flulike symptoms ( fever, arthralgia, myalgia, upper respiratory tract infections ) → indicates possible viral cause In infants and young children: poor feeding, irritability, respiratory distress, and failure to thrive Fatigue, weakness, dyspnea [amboss.com]

  Two months later, the patient was admitted again, this time with class IV NYHA symptoms: dyspnea at rest, ortopnea, paroxysmal nocturnal dyspnea. [tmj.ro]

  Summary of Chagas Cases Case 5 February 2010, a 24 year old woman from a high-risk zone for Chagas disease was admitted with 20 days of fever, asthenia, headache, dyspnea, and leg edema. [journals.lww.com]

  Symptoms are flulike; in acute myocarditis there is usually pain in the epigastric region or under the sternum (either ischemic, atypical, or pericardial), as well as dyspnea and cardiac arrhythmias. [medical-dictionary.thefreedictionary.com]

• Aspiration

  Diagnosis is by detecting trypanosomes in peripheral blood or aspirates from infected organs. Antibody tests are sensitive and can be helpful. Treatment is with nifurtimox or benznidazole. [merckmanuals.com]

  Aspiration of spleen, liver, lymph nodes, or bone marrow will frequently reveal the leishmanial form of the organism in fixed macrophages. [histopathology-india.net]

  […] with Increased Myocardial Oxygen Consumption and Reduced Cardiac Efficiency in Patients with Old Myocardial Infarction 福岡 良友，佐藤 裕介，久嵜 香，汐見 雄一郎，長谷川 奏恵，玉 直人，池田 裕之，森下 哲司，石田 健太郎，絈野 健一，天谷 直貴，宇隨 弘泰，岡沢 秀彦，夛田 浩 第82回日本循環器学会学術集会 2018年03月 Impact of Abdominal Fat Aspiration [t-profile.ad.u-fukui.ac.jp]

  Chronic chagasic megaesophagus may manifest as the following: Weight loss and, in severe cases, cachexia Hypertrophy of the salivary glands Pneumonitis related to regurgitation and aspiration of the food retained in the esophagus or stomach (particularly [emedicine.medscape.com]

  Increased Myocardial Oxygen Consumption and Reduced Cardiac Efficiency in Patients with Old Myocardial Infarction, 第82回日本循環器学会学術集会, 大阪市, 20180325 20.長谷川 奏恵，絈野 健一，久嵜 香 ，三好 真智子，汐見 雄一郎，玉 直人，池田 裕之，福岡 良友，森下 哲司，石田 健太郎，天谷 直貴，宇隨 弘泰，夛田 浩: Impact of Abdominal Fat Aspiration [fukui-u-cardio.jp]

• Pneumonia

  inflammation of the pericardium, possible extension of existing tuberculosis or pneumonia - Often presents with sharp pain (often precordial) and can often be mistaken for heart attack Benign/acute: viral (Coxsackie virus, Enterovirus) Severe: bacterial [quizlet.com]

  […] streptococcal infections ウイルス感染症、viral infections 胸部Ｘ線異常、Chest X-ray lesions; ニューモシスチス症、pneumocystosis 包虫症、echinococcosis ブラストミコーシス症、blastomycosis コクシジオイドミコーシス症、coccidioidomycosis ヒストプラズマ症、histoplasmosis 結核、tuberculosis 類鼻疽、melioidosis オーム病、psittacosis 4)肺炎、Pneumonia [amda.or.jp]

  After 55 days in the intensive care unit, the patient died because of severe sepsis caused by ventilation-associated pneumonia, catheter-related infection, and inguinal area infection. [journals.lww.com]

• Dysphagia

  Chagas megaesophagus manifests as dysphagia and may lead to pulmonary infections caused by aspiration or to severe undernutrition. Megacolon may result in long periods of obstipation and intestinal volvulus. [merckmanuals.com]

  […] orthopnea, and jugular venous distension), arrhythmias ( e.g., palpitations, weakness, and syncope), stroke ( e.g., focal neurological deficit secondary to thromboembolism formation in dilated cardiac chambers) gastrointestinal megaesophagus progressive dysphagia [medbullets.com]

  It is also important to assess digestive disorders (dysphagia, constipation, etc), since both forms can sometimes coexist. [revespcardiol.org]

  Megaesophagus is the most common anatomic finding and typically results in symptoms similar to those of achalasia, such as dysphagia, odynophagia, substernal discomfort, and a sensation that ingested food and liquids do not move forward properly. [emedicine.medscape.com]

• Intestinal Disease

  […] to antimicrobial drugs ( Z16.- ) Certain infectious and parasitic diseases B50-B64 2019 ICD-10-CM Range B50-B64 Protozoal diseases Type 1 Excludes amebiasis ( A06.- ) other protozoal intestinal diseases ( A07.- ) Protozoal diseases B57 ICD-10-CM Diagnosis [icd10data.com]

• Hepatomegaly

  […] undetected at this stage Chronic phase May manifest decades later Cardiomyopathy with arrhythmia ~20-30% of patients (Bern, 2015) Earliest sign is conduction defects – patient usually asymptomatic Symptoms of biventricular failure – peripheral edema, hepatomegaly [arupconsult.com]

  Reticuloendothelial activity and increase in the number of fixed macrophage cells cause splenomegaly, hepatomegaly, adenopathy and hyperplasia of bone marrow. The process is then a reticulopathy similar to kala-azar and histoplasmosis. [histopathology-india.net]

  […] dysentery バランチジア症、balantidiasis 赤痢、shigellosis ヘリコバクター感染症、helicobacter infection 腸侵襲性大腸菌感染症、enteroinvasive E.coli infection 慢性下痢、Chronic diarrhoea; ランブル鞭毛虫症、giardiasis クリプトスポリジウム症、cryptosporidiosis 糞線虫症、strongyloidiasis 肝吸虫症、clonorchiasis 後天性免疫不全症候群、AIDS 肝腫、Hepatomegaly [amda.or.jp]

  Hepatomegaly and splenomegaly may occur in children with acute Chagas disease, often accompanied by generalized lymphadenopathy. Varying degrees of generalized edema may occur in acutely infected persons, particularly children. [emedicine.medscape.com]

• Heart Disease

  TREATMENT OF PATIENTS WITH CHAGAS' HEART DISEASE Management of Ventricular Dysfunction and Heart Failure In general, the management of these patients has much in common with that of other heart disease. [revespcardiol.org]

  Disease : acută Pericardita și Miocardita Reumatice Heart Disease : acuta valvulara Implicarea Reumatice Heart Disease : Modificări reziduale de acută reumatice cardita Reumatice Heart Disease : mitrală Stenoza : anatomie patologica Reumatice Heart Disease [euro-libris.ro]

  […] myocardial damage in Chagas’ heart disease. [ 24, 25 ]. [jcmr-online.biomedcentral.com]

  […] pericarditis B570Acute Chagas' disease with heart involvement B572Chagas' disease (chronic) with heart involvement B5881Toxoplasma myocarditis C380Malignant neoplasm of heart C452Mesothelioma of pericardium D151Benign neoplasm of heart D1800Hemangioma [cms.gov]

• Chest Pain

  Some patients also experience cardiac signs that vary in severity from chest pain and arrhythmias to heart failure or sudden cardiac death. Infants and children typically have a more severe presentation. [amboss.com]

  Painkillers will help to ease chest pain and high temperature (fever). There is no treatment that will cure a viral infection. [patient.info]

  In other instances, the heart may be faster at revealing its struggles, with symptoms like chest pain, shortness of breath, heart palpitations, and heart failure. [healthline.com]

  Chest pain is a common symptom. [6] Symptoms of meningoencephalitis [1,6] Due to severe inflammatory reaction. Patients present with headache, neck pain and photophobia. [explainmedicine.com]

  It can present with chest pain, breathlessness, lethargy and fatigue and arrhythmias. Diagnosis is based on history, laboratory tests (to identify infective agent and inflammatory markers), ECG and echocardiography. [medical-dictionary.thefreedictionary.com]

• Heart Block

  block : right bundle branch block, complete heart block, AV block Rule out myocardial infarction : loss of R wave and pathological Q wave specific to myocardial infarction, not found in myocarditis Pericardial effusion : low voltage (low R-wave with [amboss.com]

  Patients may present with heart failure, syncope, sudden death due to heart block or ventricular arrhythmia, or thromboembolism. ECG may show right bundle branch or complete heart block. [merckmanuals.com]

  Cardiac sarcoidosis: ventricular arrhythmias, 2nd or 3rd degree heart block, no response to standard care. B. [clinicaladvisor.com]

  Eventually, dilated cardiomyopathy ensues, with arrhythmias and heart block. Segmental wall motion abnormalities and apical aneurysm may occur. Heart transplantation has been performed for end stage disease 6. [radiopaedia.org]

• Cardiomegaly

  There are bibasilar crackles on chest exam and a chest radiograph shows cardiomegaly. Echocardiogram revealed biventricular dilatation with an EF of 25%. Serological testing was positive for Trypanosoma cruzi. [medbullets.com]

  In the chronic phase of the infection, ECG alterations appear a number of years before symptoms and cardiomegaly (Table 2). [revespcardiol.org]

• Heart Murmur

  murmur シャーガス病、Chagas' disease リューマチ性心疾患、Rheumatic heart disease エンテロウイルス性心炎、Enteroviral carditis 心筋炎、Myocarditis シャーガス病、Chagas' disease リューマチ性心症、Rheumatic heart disease アフリカ型トリパノソーマ症・ローデシア種、African tripanosomiasis, Rhodesian type ＜中枢神経系の所見、Signs on Central [amda.or.jp]

• Erythema

  Mild symptoms occur for 2 weeks to 3 months Romaña sign – unilateral painless edema of palpebral and periocular tissues Initial signs include malaise, fever, anorexia, rash, and edema Acute myocarditis in small percentage of cases Indurated area of erythema [arupconsult.com]

• Periorbital Edema

  Symptoms after a Triatominae bite typically begin with a skin lesion or unilateral periorbital edema, then progress to fever, malaise, generalized lymphadenopathy, and hepatosplenomegaly; years later, some patients develop chronic cardiomyopathy, megaesophagus [merckmanuals.com]

• Peripheral Neuropathy

  In addition, peripheral neuropathy can occur late in the course of treatment. Nifurtimox frequently causes GI symptoms including anorexia, nausea, vomiting, and abdominal pain. Peripheral neuropathy can also occur late in the course of treatment. [dermatologyadvisor.com]

  Common adverse effects of benznidazole include allergic dermatitis, peripheral neuropathy, anorexia, weight loss, and insomnia. [merckmanuals.com]

• Insomnia

  Common adverse effects of benznidazole include allergic dermatitis, peripheral neuropathy, anorexia, weight loss, and insomnia. [merckmanuals.com]

Echocardiogram and cardiac MRI are the main imaging tests used in the workup of myocarditis. [clinicaladvisor.com]

• Trypanosoma Cruzi

  trypanosomiasis, Trypanosoma cruzi; infection, infection; Trypanosoma cruzi, Chagas, trypanosomiasis; American, trypanosomiasis; Trypanosoma cruzi, Trypanosomiasis, American, American Trypanosomiasis Dutch ziekte van Chagas, T. cruzi, Trypanosoma cruzi-infectie [fpnotebook.com]

  Trypanosoma cruzi (T. cruzi), Whole Cell Lysate Antigen, ORTHO® T. cruzi ELISA Test System (Package insert). Ortho-Clinical Diagnostics, Inc. 2006. Tobler LH, Contestable P, Pitina L, et al. [emedicine.medscape.com]

  Trypanosoma cruzi (CDC) Triatoma infestans Photomicrograph of Giemsa-stained Trypanosoma cruzi (CDC) Trypansoma cruzi parasite in a thin blood smear (CDC Photo) 10 Rhodnius prolixus Triatoma infestans Panstrongylus geniculatus Rhodnius prolixus nymphs [slideplayer.com]

  In reticuloendothelial cells Trypanosoma cruzi cannot be easily distinguished from species of leishmania, but only Trypanosoma cruzi invades myocardial and neuroglial cells as a leishmanial type of organism. [histopathology-india.net]

  […] involvement Chagas' disease with heart involvement Clinical Information A parasitic infection caused by trypanosoma cruzi. [icd10data.com]

• Right Bundle Branch Block

  right bundle branch block, complete heart block, AV block Rule out myocardial infarction : loss of R wave and pathological Q wave specific to myocardial infarction, not found in myocarditis Pericardial effusion : low voltage (low R-wave with poor progression [amboss.com]

  bundle branch block with left anterior hemiblock) or 3) a group of 21 patients with the cardiac phase with left ventricular systolic dysfunction determined by ejection fraction inferior to 55 % by echocardiography analysis (CPD). [jcmr-online.biomedcentral.com]

  Although there is no characteristic pattern in the ECG, these changes, especially right bundle-branch block, in isolation or associated with left anterior hemiblock in patients with positive serology, can be considered indicators of chronic Chagas' heart [revespcardiol.org]

  Inferior Pulmonary Vein Hisazaki K，Kaseno K，Hasegawa K，Amaya N，Miyazaki S，Tama N，Ikeda H，Fukuoka Y，Morishita T，Ishida K，Uzui H，Tada H 39th annual scientific session of Heart Rhythm Society 2018年05月 Recruitment of Complete Right Bundle Branch Block by [t-profile.ad.u-fukui.ac.jp]

  Cardiac symptoms A wide variety of atrial and ventricular rhythm disturbances, including right bundle branch block, left anterior hemiblock, and third-degree atrioventricular block can result in palpitations, dizziness, syncope, and even sudden death. [emedicine.medscape.com]

• Myocardial Fibrosis

  […] considered as myocardial fibrosis. [jcmr-online.biomedcentral.com]

  Chronic Chagas' Disease: The dominant factor in the chronic stages of Chagas' disease is almost always some degree of myocardial fibrosis. Many patients report a previous acute attack. [histopathology-india.net]

  Assessment of myocardial perfusion with techniques employing radioactive isotopes can be used, although their usefulness for differential diagnosis of angina pain is limited by the presence of areas of myocardial fibrosis in patients with Chagas' heart [revespcardiol.org]

Treatment Options Benznidazole and nifurtimox are the drugs available for treatment. [dermatologyadvisor.com]

Despite this chosen treatment, Chagas reactivated 7 months later, requiring additional antiparasitic treatment. Five years since, there has not been any further Chagas reactivation in the patient. [journals.lww.com]

There are two approaches to therapy of Chagas disease: antiparasitic treatment and symptomatic treatment. Antiparasitic treatment Antiparasitic treatment is most effective when given early, however acute Chagas disease often goes undetected. [dermnetnz.org]

There is no treatment that will cure a viral infection. However, for most people with viral myocarditis, the virus clears away on its own without any treatment, often within a week or so. [patient.info]

The younger the patient and the earlier treatment is started, the more likely that treatment will result in parasitologic cure. For indeterminate infections, treatment of adults up to age 50 yr has been recommended. [merckmanuals.com]

[…] is dependent on the adequacy of the residual left ventricular function, patients with severe left ventricular dysfunction having higher mortality rates. 25 In this case the early prognosis was favorable, but on the long term, the prognosis still remains [tmj.ro]

Prognosis and Patient Counseling. Prognosis varies quite a bit depending on the acuity and cause of the myocarditis as well as the patient’s ejection fraction at presentation. [clinicaladvisor.com]

Because this disease may be mild or may be extreme and cause serious arrhythmias, the prognosis varies. [medical-dictionary.thefreedictionary.com]

“Therapy, diagnosis and prognosis of chronic Chagas disease: insight gained in Argentina”. Mem Inst Oswaldo Cruz. vol. 104. 2009. pp. 167-80. (This article reviews the management of Chagas cardiomyopathy in Argentina.) [dermatologyadvisor.com]

Etiology Infectious Viral Most commonly implicated: Coxsackie B1-B5 ( picornavirus ), parvovirus B19, human herpesvirus 6 ( HHV-6 ), adenovirus, HCV, HIV, EBV, CMV, Echovirus, H1N1 influenza A Bacterial β-hemolytic Streptococcus group A (acute rheumatic [amboss.com]

Tabs Content Clinical Overview Diagnosis Indications for Testing Residency in endemic area Recent travel to endemic area Cardiomyopathy or prototypical gastrointestinal disease without obvious etiology Laboratory Testing Trypanosomiasis diagnosis (CDC [arupconsult.com]

We performed tridimensional (3D) transthoracic echocardiography to study the etiology of MR. [tmj.ro]

See also acute primary myocarditis, acute secondary myocarditis, acute septic myocarditis. myocarditis Cardiology Myocardial inflammation Etiology Idiopathic, viral, toxic Complications Dilated cardiomyopathy. [medical-dictionary.thefreedictionary.com]

A comprehensive, and profusely illustrated description of the common and uncommon images which will be found in a wide range of tropical diseases, correlated with the clinical and laboratory findings, and the epidemiology and pathology. [books.google.com]

Chagas disease is both vector-borne and zoonotic, and T. cruzi is very genetically diverse, presenting unique challenges to understand its epidemiology and pathogenesis and to develop effective control programs. [med.unc.edu]

References: [1] [2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Clinical and epidemiological aspects of Chagas disease. Lancet Infect Dis. 2001;1:92-100. Medline 5. Valente AS, Valente VC, Frahia-Neto H. Considerations on the epidemiology and transmisión of Chagas disease in the Brazilian Amazon. [revespcardiol.org]

Prata A., 2001 - Clinical and epidemiological aspects of Chagas disease. Review. The Lancet Infectious Diseases vol. 1 september 2001, 92-100. Senior K., 2007 - Chagas disease: moving towards global elimination. [books.openedition.org]

Principal Sites of Embolism from Left Artial Thrombosis Rheumatic Heart Disease: Mitral Stenosis: Thromboembolic Complications: Mitral Balloon Valvuloplasty Rheumatic Heart Disease: Mitral Regurgitation Rheumatic Heart Disease: Mitral Regurgitation: Pathophysiology [euro-libris.ro]

Pathophysiology Trypomastigotes (Figure 4), the motile forms of the parasite, invade muscle and nerve tissues of organs such as the heart and the gastrointestinal tract, causing conduction abnormalities and myopathy leading to dilatation and contractile [dermatologyadvisor.com]

These findings contribute to further the knowledge on pathophysiology of Chagas’ heart disease, and might have therapeutic and prognostic usefulness in the future. [jcmr-online.biomedcentral.com]

Left ventricular aneurysms: pathophysiologic observations and standard resection. Sem Thorac Cardiovasc Surg 1997;9:113-22. 9. Grieco JG, Montoya A, Sullivan HJ, et al. Ventricular aneurysm due to blunt chest injury. [tmj.ro]

There is neither a vaccine nor recommended drug available to prevent Chagas disease.(3). Prevention/Vaccines: Prevention of Chagas Disease: 1. Avoid sleeping in thatch, mud, or adobe houses. 2. Use bed nets if sleeping in mud or thatch houses. 3. [austincc.edu]

Prevention Although myocarditis is an unpredictable disease, the following measures may help prevent its onset. Individuals should: Take extra measures to avoid infections, and obtain appropriate treatment for infections. [medical-dictionary.thefreedictionary.com]

Other preventive measures include spraying infested dwellings with residual insecticides, using bed nets treated with insecticides, wearing protective clothing, and using insect repellant. [dermnetnz.org]

According to the Center for Disease Control and Prevention (CDC), it is estimated that as many as 8 million people suffer from this disease worldwide, many of whom are unaware of their condition. [pphr.princeton.edu]

Centers for Disease Control and Prevention Definition (NCI_CDISC) A parasitic infection caused by Trypanosoma cruzi and transmitted by the reduviid bug. [fpnotebook.com]