American trypanosomiasis, often known as Chagas disease, is a condition that can lead to severe cardiac and stomach issues.

A parasite is to blame. In Latin America, Chagas disease is prevalent, particularly in underprivileged rural areas.

It is also present in the US, usually in cases where the patient was infected prior to immigrating.

The illness still exists in endemic areas and poses a threat to millions of lives despite efforts to stop its spread.

In the America, Chagas disease affects an estimated 30,000 new cases yearly, resulting in around 12,000 deaths annually.

Approximately 9,000 newborns acquire the infection during gestation, and about 70 million people in exposed areas are at risk.

About Chagas Disease

Trypanosoma cruzi, a protozoan parasite, is the source of Chagas disease, sometimes referred to as American trypanosomiasis.

This disease, named after Brazilian physician Carlos Chagas who made the initial discovery of it in 1909, mainly affects people in Latin America, but because of travel patterns, it is becoming a global health concern. 75 million people worldwide are at risk for Chagas Disease.

Infected triatomine bugs, are the main way that people contract Chagas disease; however, organ transplants, blood transfusions, congenital transmission, and eating contaminated food can also spread the illness.

It is believed that vector-borne acute Chagas disease takes 7-14 days to incubate.

Usually, bloodsucking insects known as triatomine bugs carry the infection and disseminate it.

They also go by the name "kissing bugs" since they usually bite faces.

These insects leave behind contaminated excrement when they bite. If you rub the waste in your cut, bite wound, or eyes, you could get various Heart and gastrointestinal symptoms.

Clinical Presentation

There are acute and chronic phases to Chagas disease. The acute phase, which starts soon after infection, is characterized by fever, headaches, and muscle aches.

It can also be asymptomatic. On the other hand, it can occasionally result in serious symptoms like meningoencephalitis or myocarditis.

Following its acute phase, an infection might persist for decades before entering a chronic phase.

During this phase, the majority of people stay asymptomatic, but about 30% experience persistent problems include cardiomyopathy and gastrointestinal disorders.

cardiac issues; can include

• sudden cardiac death (cardiac arrest)

• an enlarged heart

• heart failure

• changed heart rate or rhythm

Complications related to the digestive system, such as a megaesophagus or megacolon, that might cause make trouble eating or passing stool.

If treatment for these problems is not received, serious morbidity and mortality may result.

How to Diagnose it?

Chagas disease lacks particular symptoms and presents with a variety of clinical presentations, making diagnosis difficult.

In a laboratory diagnosis, the parasite is found either directly by microscopy or indirectly by serological tests like indirect immunofluorescence assay (IFA) or enzyme-linked immunosorbent assay (ELISA).

DNA from parasites can also be found in blood samples using polymerase chain reaction (PCR).

Elimination and prevention

Due to the widespread presence of T. cruzi parasites in wild animals across the Americas, eradicating Chagas disease isn't feasible.

Instead, public health goals focus on stopping transmission to humans, ensuring prompt healthcare access, and lifelong monitoring of infected individuals.

While no vaccine exists, preventing Chagas disease relies on vector control, blood screening, and early diagnosis and treatment.

WHO advises tailored prevention and control measures based on location:

• Develop adaptable educational materials for diverse audiences

• Implement residual insecticide application to homes and nearby areas

• Enhance housing conditions and promote hygiene practices

• Encourage personal preventive actions such as bed net use and proper food hygiene

• Screen blood donors and recipients for infection

• Ensure timely access to diagnosis, treatment, and follow-up care

• Screen newborns and children born to infected mothers for the disease

Efforts to improve diagnostics and cost-effective testing algorithms are crucial for early detection. Additionally, research into disease determinants and risk factors is needed to inform prevention strategies

Treatment

Antiparasitic medication is the main treatment for Chagas disease.

Benznidazole and nifurtimox are the two major medications used in therapy.

When these medications are used in the early stages of a chronic infection or during the acute phase of the illness, they work best.

However, by stopping the progression of the illness and lowering the parasite burden, they can still be helpful in individuals with severe chronic disease.

Depending on the patient's age, disease stage, and medication tolerance, the course of treatment usually lasts 60 to 90 days. 

Adverse reactions are more common in older individuals.

These medications should not be given to pregnant women or those with kidney or liver failure, and nifurtimox is not recommended for individuals with neurological or psychiatric disorders.

Lifelong treatment and follow-up are necessary for patients with cardiac, digestive, or neurological symptoms.

Barriers and Recent Studies

There are still a number of difficulties in managing Chagas disease, despite advancements in diagnosis and therapy.

These include the rise of drug-resistant strains of Trypanosoma cruzi, restricted access to healthcare facilities, and a lack of knowledge among healthcare professionals.

Better treatment options for people with severe chronic disease are also required, as are better diagnostics for the early diagnosis of infection.

In order to increase the effectiveness of existing medications and shorten treatment times, recent research efforts have concentrated on creating novel therapeutic techniques, such as combination treatments and immunomodulatory medicines.

A study investigated a subcutaneous immunostimulant with imiquimod loaded in nanoarchaeosomes (a type of lipid vesicles, nanoarc-imq), for treating Chagas disease.

This formulation showed promising results in reducing parasitemia, inflammation, and cardiac fibrosis in acute models, surpassing standard treatment.

The simplicity and potential cost-effectiveness of lipid nanovesicle formulations make them attractive for Chagas treatment, but market availability is hindered by the lack of long-term investments and government support in endemic countries.

A study aimed to develop gene editing protocols for Rhodnius prolixus, a key vector for Chagas disease. They successfully edited genes related to eye and cuticle color, laying the groundwork for novel control strategies against Chagas vectors.