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This parasitic esophageal disease can be an unpleasant memento from an exotic vacation if we eat in random places where hygiene is not followed.
Chagas disease occurs in Latin American countries, stretching from northern Mexico to southern Argentina and Chile. The number of patients worldwide is estimated at around 16–18 million – most cases are reported in Latin America. Annually, there are about 120 thousand. new cases.
Mortality from Chagas disease is estimated at around 45-50. people per year. The main cause of death (60%) is cardiological complications, including sudden cardiac death, ventricular fibrillation, thrombotic and embolic complications, congestive heart failure, pulmonary or cerebral embolism, acute myocarditis, and meningitis.
Chagas disease – The causes of the disease
The disease is caused by the parasite Trypanosoma cruzi, which, after entering the human body, damages the mesenchymal tissue in the fetus, and in adults, the nerve ganglia in the heart, esophagus, gall bladder and intestines. The source of infection is bedbugs, and infection occurs through damaged skin, conjunctiva or oral mucosa. Other routes of transmission are blood transfusion, placenta, or organ transplantation from an ill person.
The most common cause of infection is the consumption of unprocessed food contaminated with bedbug faeces or infected insects.
A significant number of cases of infection are caused by insects that feed on blood. After being punctured, they leave faeces in the area of the wound, in which there are pathogens. In areas where the disease is most at risk, infections occur during transfusions of blood taken from a sick person. Another source is transmission of the pathogen through the placenta. The medical literature describes cases of infections during transplantation of organs taken from sick people.
The incubation period is approximately 7-10 days if the infection is passed on through the faeces of blood-sucking insects. In the case of infection by transfusion, the incubation period is about a month because the germs circulating in the bloodstream are less able to penetrate the cells.
The three stages of Chagas disease
I phase of the disease (ostra) – lasts from 1 to 3 months and during this time parasites can be detected in the blood. Unfortunately, in most cases the infection is not detected. In 5 percent patients have acute myocarditis. This usually affects children living in endemic areas. Most cases of acute myocarditis are mild and leave no permanent damage to the heart following treatment. In this phase of the disease, 5 percent die. infected people.
Usually, in the acute phase of the disease, fever, rash, lesions, skin lesions at the site of penetration of the pathogen appear, muscle pain, excessive sweating, lymphadenopathy, hepatosplenomegaly, generalized or local swelling of the subcutaneous tissue, symptoms of meningitis, acute myocarditis and acute bronchopneumonia. In the case of children, these symptoms are confused with diseases typical of childhood. This phase of the disease is successfully treated by the administration of specific antispasmodic therapy.
Phase II (undefined or latent) – it can last even 10-30 years. Sometimes the symptoms of the disease do not manifest themselves for life. The indeterminate phase begins 8-10 weeks after infection. Patients do not have any symptoms. In about 20-30 percent of infected people, the disease becomes chronic after 10-30 years.
Phase III (chronic) – the presence of parasites leads to impairment of the autonomic system innervating the heart muscle, apoptosis and myocardial fibrosis. Cases of biventricular heart failure, manifested by peripheral edema, hepatomegaly and thromboembolic events, are frequently observed.
Chronic cardiomyopathy is manifested by myocardial fibrosis and necrosis, vasculopathy, immune disorders, autonomic dysfunction, and myocarditis.
The non-cardiac symptoms of Chagas disease include enlargement of the visceral organs. This symptom is the most important symptom of the disease in the digestive system and is characterized by motor disturbances and a widening of the esophagus or colon.
In the gastrointestinal tract, there is also a loss of visceral innervation in the esophagus and colon, which leads to the formation of the so-called giant esophagus, swallowing difficulties, vomiting and constipation.
There is also a significantly increased risk of developing esophageal cancer in patients.
Diagnosis of Chagas disease
Symptoms of the disease often lead to the suspicion of esophageal achalasia (a disease based on elevated resting pressure and impaired relaxation of the lower esophageal sphincter). Radiological and endoscopic examinations do not always allow a clear diagnosis. Therefore, blood tests are performed to look for parasites in smears. Protozoa is also cultivated on special substrates. If an infection is suspected, serological tests are also performed.
Chagas Disease – Treatment
Therapy is always adapted to the stage of development of the disease and includes both fighting parasites and treating complications that have been caused by their presence. Patients are given antiprotozoal drugs. For the sake of the heart, drugs recommended in chronic heart failure, anticoagulants are used. Sometimes it is necessary to implant a pacemaker, perform ablation. The ultimate solution is organ transplantation. An important element of the treatment is also a properly selected diet and compliance with hygiene.
The disease in the acute stage is successfully treated. In the chronic phase, the prognosis is poor and the patient’s fate depends on the degree of damage to the heart muscle by parasites.
How to protect yourself?
If we go to places of high risk of infection, we must follow the rules of hygiene at almost every step. Avoid eating in street bars, carefully washing fruit and vegetables, hands and not using street toilets.
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