Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 27 2021

Chagas Disease

  • 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. Past medical history is unremarkable. Physical exam reveals an anxious-looking man in respiratory distress. Cardiovascular exam reveals an elevated JVD, S3 gallop, and pitting edema of both ankles. 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.
  • Introduction
    • Definition
      • a disease caused by Trypanosoma cruzi, a protozoan parasite, that is characterized by
        • cardiomyopathy
        • gastrointestinal disease
  • Epidemiology
    • Incidence
      • occurs predominantly in South America
    • Pathogenesis
      • reduviid bug (also known as the "kissing bug") defectates during its blood meal on humans
        • the feces contain the parasite and it infect the host through the bite wound
  • Presentation
    • Acute phase (lasts 8-12 weeks)
      • symptoms
        • malaise
        • fever
        • anorexia
        • can even be asymptomatic
      • physical exam
        • inflammation and swelling 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
    • Chronic phase
      • indeterminate form
        • asymptomatic
          • patients have T. cruzi positive serologies but no signs or symptoms of cardiac or gastrointestinal abnormalities
        • normal physical exam
          • normal 12-lead electrocardiogram (ECG)
      • determinate form
        • cardiac
          • manifestations include
            • acute myopericarditis
            • chronic fibrosing myocarditis
            • dilated cardiomyopathy
          • symptoms of heart failure
            • paroxysmal nocturnal dyspnea
            • orthopnea
            • jugular venous distension 
            • arrhythmias (e.g., palpitations, weakness, and syncope)
          • symptoms of stroke
            • focal neurological deficit
            • occurs secondary to thromboembolism formation in dilated cardiac chambers
        • gastrointestinal
          • megaesophagus
            • progressive dysphagia and regurgitation of food
          • megacolon
            • progressive constipation, colicky abdominal pain, and bloating
  • Studies
    • Blood smear
      • trypomastigote (motile, flagellated form) in blood smear
    • Polyermase chain reaction (PCR)
    • Serology
      • enzyme-linked immunosorbent assay (ELISA)
  • Differential
    • Alcohol-induced dilated caridiomyopathy
      • differentiating factor
        • patients will have a history of alcohol use disorder
  • Treatment
    • Medical
      • antitrypanosomal therapy
        • indication
          • first-line treatment for Chagas disease
        • medications
          • benznidazole 
          • nifurtimox
  • Complications
    • Dilated cardiomyopathy
    • Cardiac arrest
    • Thromboembolic events (e.g., stroke)
    • Bowel ischemia
    • Malnutrition
1 of 0
1 of 2
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options