Diagnosis, Management, and Treatment of Chronic Chagas' Heart Disease in Areas Where Trypanosoma cruzi Infection Is Not Endemic

• Published in: Revista española de cardiologia 2007-03, Vol.60 (3), p.285-293
• Main Authors: Gascón, Joaquim, Albajar, Pedro, Cañas, Elías, Flores, María, Prat, Jordi Gómez i, Herrera, Ramón N., Lafuente, Carlos A., Luciardi, Héctor L., Moncayo, Álvaro, Molina, Lluís, Muñoz, José, Puente, Sabino, Sanz, Ginés, Treviño, Begoña, Sergio-Salles, Xavier
• Format: Article
• Language: eng ; spa
• Subjects: Animals; Arrhythmia; Arritmia; Cardiopatía; Chagas Cardiomyopathy - complications; Chagas Cardiomyopathy - diagnosis; Chagas Cardiomyopathy - therapy; Chagas' disease; Enfermedad de Chagas; Heart disease; Humans; Muerte súbita; Sudden death; Trypanosoma cruzi
• ISSN: 1885-5857; 1885-5857; 1579-2242
• DOI: 10.1016/S1885-5857(07)60153-4

Chagas' disease, or American trypanosomiasis, is a parasitic zoonosis found only in the Americas. Under natural conditions, Trypanosoma cruzi is transmitted by insects belonging to different species of Triatoma. However, several routes of transmission that do not involve insect vectors have also been described, such as transmission via blood products or transplantation of infected organs, and vertical transmission. At present, the number of people infected with Chagas' disease worldwide is estimated to be about 10–12 million. The process of urbanization in Latin America and migratory population movements from endemic countries have led to the disease being diagnosed in non-endemic areas. It is estimated that 20%–30% of individuals infected with T. cruzi will develop symptomatic heart disease at some point during their lives. The specific differential characteristics of chronic chagasic cardiopathy, lack of knowledge of the disease among many healthcare workers, and the fact that arrhythmia or sudden death is frequently the first manifestation of disease all make it essential that diagnostic and therapeutic protocols for the disease are developed and disseminated. The aim should be to improve patient care by increasing understanding of the condition by physicians and other healthcare professionals who may be involved in its detection and treatment. La enfermedad de Chagas o tripanosomiasis americana es una parasitosis originaria del continente americano. En la naturaleza, Trypanosoma cruzi se transmite vectorialmente a través de diversas especies de chinches triatominos. No obstante, se han descrito otros mecanismos de transmisión no vectorial, como la transmisión a través de productos sanguíneos o mediante el trasplante de órganos infectados, y la transmisión vertical. Actualmente, la enfermedad de Chagas afecta a unos 10–12 millones de personas en el mundo y el proceso de urbanización en América Latina y los movimientos migratorios desde los países endémicos han posibilitado que la enfermedad de Chagas sea diagnosticada en zonas donde la infección no es endémica. Se considera que un 20–30% de las personas infectadas por T. cruzi desarrollarán a lo largo de su vida alteraciones cardiacas. Las características di-ferenciales de la cardiopatía chagásica, el escaso conocimiento que se tiene de ella en nuestro medio y la elevada frecuencia de arritmias y muerte súbita como primeras manifestaciones potenciales de esta enfermedad hacen prioritarias la elaboración