Trypanosoma cruzi - Revision history

Aidan at 15:43, 6 March 2023

2023-03-06T15:43:39Z

← Older revision		Revision as of 15:43, 6 March 2023
Line 31:		Line 31:
	==Clinical Manifestations==		==Clinical Manifestations==

	===Acute ~~disease~~===		===Acute Disease===

	*Often asymptomatic		*Often asymptomatic
Line 43:		Line 43:
	*Acute myocarditis, pericardial effusion, and meningoencephalitis in 1-5%		*Acute myocarditis, pericardial effusion, and meningoencephalitis in 1-5%

	===Indeterminate ~~phase~~===		===Indeterminate Phase===

	*Following acute infection, may enter a latent phase		*Following acute infection, may enter a latent phase

	===Chronic ~~disease~~===		===Chronic Disease===

	*Following acute infection can remain asymptomatic (indeterminate form)		*Following acute infection can remain asymptomatic (indeterminate form)
Line 62:		Line 62:
	*Other: polyneuropathy, stroke syndrome		*Other: polyneuropathy, stroke syndrome

	===Immunocompromised ~~patients~~===		===Immunocompromised Patients===

	*May have reactivation following immune suppression or HIV		*May have reactivation following immune suppression or HIV
Line 70:		Line 70:
	==Diagnosis==		==Diagnosis==

	===Acute ~~disease~~===		===Acute Disease===

	*'''Direct microscopy''' blood film or tissue biopsy (e.g. lymph node, bone marrow, pericardial fluid, CSF)		*'''Direct microscopy''' blood film or tissue biopsy (e.g. lymph node, bone marrow, pericardial fluid, CSF)
Line 79:		Line 79:
	*Xenodiagnosis		*Xenodiagnosis

	===Indeterminate and ~~chronic~~ ~~disease~~===		===Indeterminate and Chronic Disease===

	*No gold standard		*No gold standard
Line 96:		Line 96:
	**However, treatment may not result in parasitologic cure		**However, treatment may not result in parasitologic cure
	*Treatment options		*Treatment options
	**Nifurtimox: 90-120 day treatment course; AEs include anorexia, ~~weightloss~~, neurologic symptoms		**Nifurtimox: 90-120 day treatment course; AEs include anorexia, weight loss, neurologic symptoms
	**Benznidazole: 60 day treatment course; AEs include hypersensitivity, GI upset, rare polyneuropathy and agranulocytosis		**Benznidazole: 60 day treatment course; AEs include hypersensitivity, GI upset, rare polyneuropathy and agranulocytosis
	*Adverse events are common during treatment		*Adverse events are common during treatment

Aidan at 14:02, 5 August 2020

2020-08-05T14:02:22Z

Show changes

Aidan: Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

2020-08-02T10:51:33Z

Text replacement - "== Clinical Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 10:51, 2 August 2020
Line 31:		Line 31:
	* Parasitemia maintained for years		* Parasitemia maintained for years

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	=== Acute disease ===		=== Acute disease ===

Aidan at 12:53, 16 August 2019

2019-08-16T12:53:38Z

← Older revision		Revision as of 12:53, 16 August 2019
Line 124:		Line 124:

	{{DISPLAYTITLE:''Trypanosoma cruzi''}}		{{DISPLAYTITLE:''Trypanosoma cruzi''}}
	[[Category:~~Parasites~~]]		[[Category:Protozoa]]

Aidan at 12:23, 16 August 2019

2019-08-16T12:23:48Z

← Older revision		Revision as of 12:23, 16 August 2019
Line 1:		Line 1:
			* Causes '''Chagas disease''' (South American trypanosomiasis)

	== Microbiology ==		== Microbiology ==

	* Protozoan parasite ~~that causes Chagas disease (South American trypanosomiasis)~~		* Protozoan parasite

	== Life Cycle ==		== Life Cycle ==

Aidan at 12:23, 16 August 2019

2019-08-16T12:23:25Z

← Older revision		Revision as of 12:23, 16 August 2019
Line 1:		Line 1:
	= ''Trypanosoma cruzi'' (Chagas disease) =

	== Microbiology ==		== Microbiology ==

Line 122:		Line 120:
	* Samples are only tested for antibodies when increased risk is present, determined by the donor screening questions		* Samples are only tested for antibodies when increased risk is present, determined by the donor screening questions
	* No reported cases since screening began in 2010		* No reported cases since screening began in 2010

			{{DISPLAYTITLE:''Trypanosoma cruzi''}}
			[[Category:Parasites]]

Aidan: Aidan moved page Trypanosoma cruzi (Chagas disease) to Trypanosoma cruzi without leaving a redirect

2019-08-16T12:22:31Z

Aidan moved page Trypanosoma cruzi (Chagas disease) to Trypanosoma cruzi without leaving a redirect

← Older revision	Revision as of 12:22, 16 August 2019
(No difference)

Maintenance script: Imported from text file

2019-08-11T18:06:01Z

Imported from text file

New page

= ''Trypanosoma cruzi'' (Chagas disease) =

== Microbiology ==

* Protozoan parasite that causes Chagas disease (South American trypanosomiasis)

== Life Cycle ==

[[File:Chagas_LifeCycle_19.jpg|T. cruzi Lifecycle]]

== Epidemiology ==

* Endemic '''throughout the Americas''' from the southern half of the United States to Argentina
** Particularly in rural, impoverished areas
** A small number of autochthonous cases of Chagas disease in the US
* Reservoirs include '''armadillos''', opossums, raccoons, woodrats, some other rodents, and domestic dogs
* '''Triatomine''' vector species for trypanosomiasis belong to the genera ''Triatoma'', ''Rhodnius'', and ''Panstrongylus''
** Bugs live in substandard dwellings (especially wood, mud, or stone houses)
** Vector is present from southern US to southern Argentina
** Transmission is via feces, either in direct contact with mucous membranes (especially conjunctivae), breaks in the skin, or contaminating the bite of the insect
* Can also be transmitted via '''blood transfusion''' or '''vertically''' from mother to child or via '''ingestion''' of contaminated food and drink

== Pathophysiology ==

* Infective metacyclic trypomastigotes from feces enter the skin or mucosa
* Multiply in host cells as amastigotes, developing into trypomastigotes intracellularly and rupturing the cell, releasing more trypomastigotes
** Chagoma develops at site of inoculation
** Intracellular amastigotes visible as characteristic pseudocysts on histopathology
* Hematogenous spread to distant sites, especially muscles, with the cycle repeating
** Especially tropic for myocardium, where it causes biventricular enlargement, thinning of ventricular walls, apical aneurysms, and mural thrombi
* Parasitemia maintained for years

== Clinical Presentation ==

=== Acute disease ===

* Often asymptomatic
* Incubation period of about 1 week
* Usually mild febrile illness, sometimes with hepatosplenomegaly, rash, edema, local inflammation
** Incurs in 20% of infections
** More common in children
* Nodular lesions ("chagomas") may develop at site of inoculation
** Romaña sign if periorbital, often with ipsilateral lymphadenopathy
** Often 1-2 weeks after exposure
* Acute myocarditis, pericardial effusion, and meningoencephalitis in 1-5%

=== Indeterminate phase ===

* Following acute infection, may enter a latent phase

=== Chronic disease ===

* Following acute infection can remain asymptomatic (indeterminate form)
* Cardiac complications in 25-30% (1.5-5% per year)
** Non-ischemic dilated biventricular (right more than left) cardiomyopathy with heart failure
** Apical aneurysms and mural thrombi
** Conduction defects, with heart blocks, bundle branch blocks, sinus node dysfunction, bradycardia, and ventricular arrhythmias
** Can cause sudden cardiac death
* GI involvement in 10-15%
** Megaesophagus, with dysphagia, odynophagia, chest pain, cough, and regurgitation
*** May result in aspiration and recurrent pneumonias
** Megacolon, with constipation and abdominal pain
* Meningoencephalitis
* Other: polyneuropathy, stroke syndrome

=== Immunocompromised patients ===

* May have reactivation following immune suppression or HIV
* Severe acute infection; may have skin lesions and cerebral masses/abscesses
* Meningoencephalitis

== Diagnosis ==

=== Acute disease ===

* '''Direct microscopy''' blood film or tissue biopsy (e.g. lymph node, bone marrow, pericardial fluid, CSF)
** In immunocompromised, these other samples are even more important
* Hemoculture is only 50% sensitive and takes several weeks
* Serology for IgM is useless
* '''PCR''' is sensitive and specific
* Xenodiagnosis

=== Indeterminate and chronic disease ===

* No gold standard
* Serology for IgG is most useful
** Detectable after 6 to 9 months following infection
** Many assays (ELISA, indirect hemagglutination, chemiluminescence, and IFA)
* PCR (of blood) less sensitive

== Management ==

=== Acute ===

* Treatment is most useful in acute disease, congenital Chagas, and children with chronic infection up to 18 years
** It can decrease illness severity and mortality
** Start ASAP before infection can become established
** However, treatment may not result in parasitologic cure
* Treatment options
** Nifurtimox: 90-120 day treatment course; AEs include anorexia, weightloss, neurologic symptoms
** Benznidazole: 60 day treatment course; AEs include hypersensitivity, GI upset, rare polyneuropathy and agranulocytosis
* Adverse events are common during treatment

=== Chronic ===

* Less clear benefit to antiparasitic treatment
* Cardiac disease
** May benefit from pacemaker in patients with conduction disease
*** Monitor with ECG q6mo
** May need heart transplantation, though this can become complicated by ongoing chronic infection or recrudescence
* Megaesophagus: balloon dilatation or surgical management
* Megacolon may need surgical management

== Prevention ==

* Screening immigrants and then following up with regular cardiac screening, if positive
* Avoid sleeping in dilapidated dwellings in endemic countries, use insect repellent and bed nets
* Improve housing in endemic areas

=== Canadian Blood Services ===

* Samples are only tested for antibodies when increased risk is present, determined by the donor screening questions
* No reported cases since screening began in 2010